Permit CITY OF TIGARD SEWER CONNECTION PERMIT
41
1. ' COMMUNITY DEVELOPMENT
Permit#: SWR2021-00071
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/18/2021
Parcel: 2S107AA16800
Jurisdiction: Tigard
Site address: 14218 SW 165TH AVE
Project: Polygon at Roshak Ridge,Lot 168 Subdivision: ROSHAK RIDGE Lot: 168
Project Description: Sewer connection for new detached dwelling unit
Contractor: Owner: POLYGON WLH LLC
703 BROADWAY ST STE 510
VANCOUVER,WA 98660
PHONE: PHONE:
FAX:
FEES
Description Date Amount
Specifics: Sewer Connection Fee 04/12/2021 $5,800.00
Sewer Inspection-Residential 04/12/2021 $35.00
Type of Use: SF
Class of Work: NEW
Install Type: Line Tap and Building Sewer
Fixture Units:
Number of Dwelling Units: 1
Total $5,835.00
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those'/ rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
Issued By:�el�� _ G^ . Permittee Signature: Qom'✓ <i f d'�e!e
1 ) vvK 11 J 12-7-7v
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.